Commanding Hope: The Power We Have to Renew a World in Peril
Alfred A. Knopf Canada, 2020
Reviewed by Johny Van Aerde, MD, PhD
Thomas Homer-Dixon is a complexity scientist and the executive director of the Cascade Institute at Royal Roads University in Victoria. His latest book, Commanding Hope, was released during the second COVID-19 wave. It describes a realistic type of hope that we need at this time of the Anthropocene and that leads to change by action. Although it deals mainly with the survival of humanity within the entanglement of deteriorating environmental conditions, extreme economic stresses, the global spread of new infectious agents, mass migration, and increasing social instability, the main premise of the book can also be applied to our health care system, which is intertwined with many other complex systems in distress.
Homer-Dixon’s definition of hope is a state of mind, a person’s longing for an imagined, better future. For hope to be a motivating force, it must be positive — a worldview that enables people to see what else is possible. Our individual and collective mental models, beliefs, and perspectives can prevent us from seeing alternative possibilities. Hope is a necessary leadership trait because without hope any situation is unsalvageable and suffused in despair, and there is the belief that things are inevitable and we can do nothing to affect them.
Also, change and transformation can only take place through agency inspired by hope. Hope must be combined with some action toward the desired change. That is where Homer-Dixon makes a distinction between avoiding the timid and passive locution of “hope that” (i.e., something magical will happen without any responsibility to take action) and striving for the bold and active “hope to”, (i.e., a willingness to become an agent to create the desired future).
“Hope to” or “commanding hope” has three characteristics: it is honest, astute, and powerful. Honest hope is a moral attitude because it starts from presumption of the moral importance of a commitment to truth and evidence. It means having the courage to fully acknowledge the difficulties we face, informed by evidence, by understanding the stark constraints, while recognizing alternative possibilities within existing or new constraints in changing systems. Lack of honesty leads to false hope. In honest hope, “truth” is a scientifically defensible concept fundamentally tied to trust issues. It makes this reviewer think that, for the health care system, honest hope means imagining new possibilities for the future in the context of the current evidence of severe constraints, resource shortages, increasing demands, and existing successful models of alternative care delivery. What would be a realistic vision of our health care system, and what can realistically be accomplished?
Astute hope is an epistemological attitude because it is grounded in deep knowledge of people’s worldviews and motivations. It requires us to leverage a savvy understanding of our allies’ and opponents’ motivations and worldviews, starting from the assumptions that, among our opponents, are good people whom we can mobilize. This aligns (or should align) with the health care system’s foundational values of caring, kindness, and compassion. Astute hope is strategically smart, as it makes us more successful on the pathway to our desired future if we develop an understanding of the worldviews and motivations of the diverse people we encounter. It also gives us insight into how our worldview or action might be perceived by others, and how they might respond, thereby allowing us to adjust our course of action. An example in our health care system might be understanding and having conversations on polarities, such as public and privatized health care, primary general care and specialized tertiary care, hospital and community care, curing disease and caring for people.
Commanding hope is also powerful, as it is a psychological attitude that emphasizes a vision of a positive future with a commitment to agency. Powerful hope motivates us to push through adversity and work to solve critical problems as illuminated by honest and astute hope. Its power comes from a pragmatic vision of the future that really matters to us, especially one that invigorates us with moral passion and excitement. The vision must reflect clearly defined values, goals, and identities that bring Canadian citizens together around a compelling purpose with a feeling of “we-ness.” As we don’t have a common vision on how to establish health care for all citizens, perhaps a better, smaller example might be actions related to the slogan “We are in this together” during the first wave of the pandemic.
Homer-Dixon then turns to systems thinking and complexity science to apply the three dimensions of hope to solving today’s major issues. The combinations and interactions can lead to a staggeringly large number of knowable and unknowable possibilities that can command hope by providing realistic innovations to be used as agencies of change. The author quotes Donella Meadows’ 12 places where interventions in a system can be influential. The top three are goals of the system, the paradigm or worldview out of which the system arises, and, at the top, the power to transcend worldviews or paradigms.1
How can these three interventions be applied to our health care system? The goal of a system is the leverage that is superior to the self-organizing ability of a system and must be defined by all stakeholders affected by the system. For the health care system, Canadians need to define its goal and purpose. The system that served our grandparents was never refined as the world changed, and it subsequently collapsed. As we redesign it, would the new leverage point shift to health for all Canadians rather than disease treatment, as pointed out by several royal commissions, but never really implemented?
Such a new goal would be closely linked with and superseded by another leverage point, the worldview or paradigm out of which the system arises. If the worldview favours individualism rather than collectivity, and if the politics of a worldview are kept in place by short-term election cycles, then the goal is unlikely to be reached.
Finally, and most important, is the capacity to transcend worldviews and paradigms. Do Canadians, health care professionals, politicians, and citizens have the skills to realize that no one single paradigm is true, that every paradigm, including our own, is a very limited understanding of the large number of possibilities beyond our current understanding. Why does Canada resist any possible variation on integrating components of private health care with the public health system, as is done successfully in countries outside north America? Do we have the power, the capacity, to shift our limited thinking from curing diseases to include socioeconomic factors that cause those diseases?
Underlying many of today’s problems are inequities in many of our human-made systems, most of which influence people’s health and their use of the health care system. If we want to avoid the global calamity of collapsing systems, including health care, if we want to reverse the collective slide, we must address the world’s agonizing social and economic injustices. This implies expanding our identity from individualism to we-ness, as we, all Canadians and all world citizens, are in this together. As Homer-Dixon states, “the closer we look, the more it appears that the thing we are really up against is ourselves.” Although all domains of the LEADS framework are needed for “commanding hope” to be honest, astute, and powerful, the most important leadership skills will be emotional intelligence, skillful dialogue and listening.
1.Meadows D. Leverage points: places to intervene in a system. Hartland, Vt.: Sustainability Institute; 1999. Available: https://tinyurl.com/2awee4cc
Johny Van Aerde, MD, PhD, FRCPC, is former executive medical director of the Canadian Society of Physician Leaders and founding editor of the Canadian Journal of Physician Leadership.